This retrospective review showed that anterior segment OCT (AS-OCT) can be used to identify patients at high risk for posterior capsule rupture, but it’s unclear whether including imaging in a routine preop cataract evaluation is worth the extra time and expense.

It would appear an option in high-risk cases, allowing for better surgical planning and preop counseling. Still, the quality of the information conveyed remains to be seen. For example, this series included cases in which the imaging suggested the absence of an intact posterior capsule, but during surgery the capsule was found to be intact.

The investigators in this series used AS-OCT to screen 37 eyes with posterior polar cataract and no obvious capsule tear observed clinically. Each eye was then graded on a system the authors created based on the presence or absence of an intact posterior capsule and the amount of adhesion between the posterior opacity and the capsule, as seen on AS-OCT.

When the eyes with a moderate to high chance of PCR were compared with eyes in the lowest risk category, the test sensitivity was 87.5%. The authors write that although the specificity was only 62.1%, the high test sensitivity served to alert the surgeons about the PCR risk, allowing them to plan better for surgery and provide better preoperative counseling.